Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies

Ke, Li-Shan; Huang, Xiaoyan; O'Connor, Margaret Mary; Lee, Susan

doi:10.1111/jocn.12853

Cited by 121 publications

(150 citation statements)

References 37 publications

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“…The study from Canadian scientists disclosed that only 19% of physicians would discuss the AD issues in general, while more than half of them reported they would not to comply with their patients’ (AD) will expressed in in certain situation [22]. Similar results were reported by Japanese scholars: 55% of study participants (physicians) support AD application, while 33% of them had a possibility to discuss it with their patients in clinical practice [23]. …”

Section: Discussionmentioning

confidence: 68%

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Peičius

Blaževičienė

2017

BMC Med Ethics

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BackgroundThis paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals’ understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania.MethodsA cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods.ResultsThe analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents’ profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice.Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives.ConclusionsThe study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD’s improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

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Section: Discussionmentioning

confidence: 68%

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Peičius

Blaževičienė

2017

BMC Med Ethics

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“…Several systematic reviews have focussed on either healthcare professionals' knowledge (Kermel-Schiffman & Werner, 2017), attitudes (Ke, Huang, O'Connor, & Lee, 2015) or practices (Jabbarian et al, 2018) towards ACP, mainly exploring these categories independently. The advantage of focussing on KAPs is that all domains of knowledge, attitude and practices are assessed, and these can be analysed in relation to each other, exploring potential interactions.…”

Section: Introductionmentioning

confidence: 99%

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Blackwood

Walker

Mythen

et al. 2019

Journal of Clinical Nursing

110

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Introduction Advance care planning is a means for patients to communicate their wishes, fears and desires for future health decisions should they lose the ability to consider or communicate these. Despite being supported by governments and healthcare leaders, uptake amongst the general population remains low. Nurses play a crucial role in promoting and engaging with these discussions given their close relationship with patients and families in a range of clinical settings. Aim To describe the barriers that nurses and healthcare professionals believe prevent them from exploring advance care planning with their patients. Method We carried out a systematic review of peer‐reviewed journal articles from the databases MEDLINE, Embase, CINAHL Plus, Web of Science and ProQuest Central, guided by the PRISMA checklist. Results Eleven articles were identified: all were self‐reporting surveys using a mix of open and closed questions. They originated in the USA, Canada, Australia and Ireland. The participants included various healthcare professionals, with the majority of studies focussing on nurses. The two most important barriers to advance care planning are lack of education and insufficient time. Advance care planning appears to be well supported, and nurses and healthcare professionals report themselves to be comfortable and confident to take on the responsibility. Conclusion There is a need for greater education and training for nurses and healthcare professionals. In particular, there needs to be better understanding of professional and legal responsibilities. The need for sufficient time to be made available to allow these conversations, in often busy settings, will need institutional and financial support. Relevance to clinical practice Increased training and knowledge are likely to lead to more positive attitudes and greater confidence for nurses, and other healthcare professionals, which should help support and encourage patient engagement with advance care planning.

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“…21,22 The importance of effective MDT working, and the contribution of community nurses who are described as 'distressingly overstretched', was widely reflected in the present results and has been described previously. 23,24 Community nursing is highly valued by GPs, particularly in terms of building relationships with patients at the end of their lives and with their families, delivering symptom-control medication, completing holistic assessments, and taking a proactive role in advanced care planning discussions. A lack of responsive services, particularly access to hands-on nursing or social care, was also highlighted.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Providing end-of-life care in general practice: findings of a national GP questionnaire survey

et al. 2016

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BackgroundWith increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of highquality palliative and end-of-life care (EOLC). AimTo provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care. Design and settingA web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs. MethodResponses were analysed using descriptive statistics and an inductive thematic analysis. ResultsResponses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care -which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors -with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management -including effective symptomcontrol and access to specialist palliative care services; and expertise and training -the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC. ConclusionThe findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care.

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Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies

Abstract: The findings provide nurses and administrators with information to develop related policies and education. Additionally, the appointment of nurses to formal roles related to advance care planning is appropriate and warranted.

Cited by 121 publications

References 37 publications

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Providing end-of-life care in general practice: findings of a national GP questionnaire survey

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